Patient-centered Care Transitions in Heart Failure: A Pragmatic Cluster Randomized Trial
- Conditions
- Heart Failure
- Interventions
- Other: PACT-HF Model
- Registration Number
- NCT02112227
- Lead Sponsor
- Population Health Research Institute
- Brief Summary
Heart failure (HF) is the most common cause of hospitalization in older adults. The month after hospital discharge represents a vulnerable period, when patients are at increased risk of death and readmission to hospital. Research has shown that certain discharge-planning services can reduce death and readmissions, but these have not been widely implemented. In this study, we will group evidence-informed discharge-planning services into 'Patient-centered Care Transitions in HF' (PACT-HF), a model of care that will prepare patients for their transition from hospital to home. Through PACT-HF, patients will benefit from a comprehensive assessment of their health care needs, learn to recognize and manage symptoms of HF, and receive the information and follow-up care needed to optimize their health. We will introduce PACT-HF to 10 Ontario hospitals over a number of time periods using a stepped wedge cluster trial design. We will compare the outcomes (hierarchically ordered) of patients in hospitals with PACT-HF to those in hospitals without PACT-HF. We anticipate that patients hospitalized at the sites with PACT-HF will have fewer readmissions, emergency visits, and deaths after discharge; report a better quality of life; and feel more prepared for discharge. We also anticipate that overall, PACT-HF will reduce health system costs.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 3500
- In participating hospitals, all patients hospitalized with the most responsible diagnosis of Heart Failure
- Patients who die during hospitalization or are transferred to another hospital
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Discharge planning services PACT-HF Model Proven effective discharge-planning services will be grouped into 'patient-centered care transitions in heart failure' patients. This will be known as the PACT-HF model.
- Primary Outcome Measures
Name Time Method Time to composite all-cause readmissions/emergency department (ED) visits/death at 3 months Within 3 months of hospital discharge Time to composite all-cause readmissions/emergency department (ED) visits/death at 30 days Within 30 days of hospital discharge
- Secondary Outcome Measures
Name Time Method Health Care Costs 6 months post discharge Total health care system costs per patient, using the viewpoint of the Ministry of Health. This will be measured using administrative databases.
Preparedness for discharge On admission, at 6 weeks and 6 months post discharge Patient-centered outcome, as measured by a validated survey instrument
Quality of life, as measured by the EQ5D5L scale Administered on admission for HF and also 6 weeks and 6 months post discharge Health-related quality of life, as measured by the validated EQ5D5L scale. This will be administered on admission and within 6 weeks and 6 months of the patient's discharge.
Trial Locations
- Locations (1)
Population Health Research Institute of McMaster University and Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada